RT-PCR法检测肺癌患者区域性淋巴结微转移的临床病理相关性分析

Clinicopathological correlation of detection of regional lymph nodes micrometastasis in patients with lung cancer by reverse transcriptase-polymerase chain reaction

目的 分析RT PCR法检测区域性淋巴结中肺癌微转移的临床病理相关性。方法 区域性淋巴结共 2 61枚 ,取自 40例接受手术治疗的原发性肺癌患者 ,将每枚淋巴结均分为两等份 ,分别进行病理学检测和细胞骨架角蛋白 19(CK1 9)基因的表达分析。结果 18例患者同时被病理检查和RT PCR法证实存在淋巴结转移 ;另 2 2例病理学检查未检测到淋巴结转移 ,但RT PCR法检测到其中 6例存在淋巴结肺癌微转移。40例患者中 ,RT PCR法显示淋巴结转移与肿瘤大小、癌肿侵犯血管、肿瘤分化等级和肿瘤的P TNM分期有密切关系 (P <0 .0 5 )。 2 2例病理检查未发现淋巴结转移的患者中 ,淋巴结微转移与肿瘤大小和肿瘤的P TNM分期有密切关系 (P <0 .0 5 )。普通病理检查则显示淋巴结转移与否与患者的各临床病理指标之间无明显关系。结论 RT PCR法在检测淋巴结转移方面较普通病理检查优越 ,它能准确地检测到存在于淋巴结中的肿瘤微小转移灶 。

Objective To analyze clinicopathological correlation of detection of lung cancer micrometastasis in regional lymph nodes (LNs) by reverse transcriptase polymerase chain reaction (RT PCR). Methods Regional LNs (n=261) were obtained from 40 patients with lung cancer who underwent lobectomy. Each LN was bisected. Half of each LN was subjected to histological examination (HE) and the other half was subjected to RT PCR amplification of CK 19 mRNA. Results In 18 of 40 patients, the metastasis in regional LNs was found by both HE and RT PCR. Of 22 N0 diseases diagnosed by HE, 6 (27%) were found to express CK 19 mRNA in regional LNs. According to the results of regional LNs metastasis in 40 patients by CK 19 RT PCR, the presence of the CK 19 product in LNs was related to tumor size (χ 2=5.76, P<0.025), the presence of tumor vascular invasion (χ 2=3.88, P<0.05), cell differentiation of the tumor (χ 2=7.08, P<0.01) and P TNM stages (χ 2=7.42, P<0.01). In the histologically node negative patients, lymph node micrometastasis was significantly related to tumor size (P=0.038, exact test) and P TNM stage (P=0.01, exact test). However, the results of routine histological examination did not show the above clinicopathological correlation (P>0.05). Conclusion The RT PCR method is superior to routine histological examination in detecting metastasis in LNs. The micrometastasis in LNs can be detected accurately by RT PCR. It is helpful for screening the patients in whom the early subclinical metastasis exists and disclosing the intrinsic rule of malignancy metastasis.